Leprosy Mailing List – October 20, 2013
Ref.: (LML) MB patients without clear treatment status and chronic ENL
From: Stephen Walker, London, UK
Dear Pieter
I would like to refer to the letter of José Augusto of October 17, 2013 and thanking him for sharing this scenario with us.
Such decisions need to be made on an individual basis for each patient given the information available and its reliability. It is also important to ensure that they are adherent to their ENL treatment and have no underlying intercurrent medical problems driving the reaction.
I think there are good reasons for instituting MB MDT in these patients:
1. It ensures that one can be confident they have been adequately treated with respect to infection.
2. There may be some anti-ENL benefit from clofazimine
3. MB MDT was previously given for longer than 12 months to all patients and the Global Strategy allows for the extension of MB treatment in highly smear positive individuals beyond 12 months. Therefore recognising that in these individuals there are benefits to extending treatment. In Section 5.2 Enhanced Global Strategy 2011-15: "Rarely, it may be considered advisable to treat a patient with a high Bacterial Index (BI) for more than 12 months. This decision may only be taken by specialists at referral units after careful consideration of the clinical and bacteriological evidence."
Having said all that I am not aware of any evidence to suggest that this approach will shorten the duration or reduce severity of the ENL in the situation you describe.
The LML is a good forum to get other views and via the ENLIST LinkedIn board/email list.
Best wishes,
Steve
Dr Stephen Walker PhD MRCP(UK) DTM&H
Consultant Dermatologist and Clinical Research Fellow
Department of Clinical Research
Faculty of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel St
London
WC1E 7HT
44 20 7612 7863
44 7847 187831
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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